Abstract
Purpose
The authors present the findings of contrastenhanced electrocardiogram (ECG)-gated cardiac computed tomography (CT) in 18 patients with probably spontaneous closure of muscular ventricular septal defect (VSD).
Materials and methods
The study included 2,725 consecutive patients referred to our hospitals for multidetector computed tomography (MDCT) coronary angiography. The patients were between the ages of 5 and 78 [mean±standard deviation (SD) 59±13.86] years, and 1,816 (66.6%) were male. Evaluating the images for coronary artery pathologies revealed pouches or sacs in the central muscular location of the septa of some patients.
Results
All patient records were retrospectively reviewed, and 18 patients were found to have pouches or sacs in the interventricular septum location likely to be spontaneous closure of muscular VSD (0.66% prevalence). MDCT findings of these 18 patients correlated with their echocardiographic findings. Of the patients with muscular VSD, 13 were male and five were female. These 18 patients were initially referred due to indications such as chest pain (n=11), risk-factor assessment (n=3), coronary artery anomaly (n=1), suspected aberrant right subclavian artery due to dysphagia (n=1) and coronary artery bypass graft (n=2).
Conclusions
Our study shows that the incidence of spontaneous closure of muscular VSD with central septum location is probably higher than expected. Thus, some patients initially diagnosed with ventricular diverticula with an apical and marginal septum location may actually have spontaneously closed muscular VSD. This finding may affect previously reported rates of both ventricular diverticula and spontaneous closure of muscular VSD.
Riassunto
Obiettivo
Gli autori presentano i risultati della tomografia computerizzata (TC) cardiaca con l’utilizzo di gating cardiaco e con somministrazione di mezzo di contrasto in 18 pazienti con probabile chiusura spontanea del difetto del setto interventricolare.
Materiali e metodi
Lo studio include 2.725 pazienti consecutivi esaminati mediante TCMS delle arterie coronarie. L’età dei pazienti era compresa tra 5 e 78 anni (media ± DS 59±13,86) di cui 1816 (66,6%) di sesso maschile. In alcuni pazienti, la valutazione delle immagini alla ricerca di patologia coronaria rivelò la presenza di tasche o sacche nel muscolo cardiaco a livello del setto.
Risultati
Tutta la documentazione raccolta è stata rivalutata retrospettivamente. Diciotto pazienti presentavano una tasca o una sacca a livello del setto interventricolare, verosimile espressione di chiusura spontanea del difetto interventricolare (prevalenza 0,66%). I reperti della TCMS di questi 18 pazienti sono stati correlati con i reperti ecocardiografici. Dei pazienti con difetto del setto interventricolare, 13 erano maschi e 5 femmine. Questi 18 pazienti erano stati inizialmente indagati in seguito ad indicazioni quali dolore toracico (n=11), valutazione dei fattori di rischio (n=3), anomalia coronarica (n=1), sospetto di arteria succlavia destra aberrante in seguito a disfagia (n=1) e bypass coronarico (n=2).
Conclusioni
Il nostro studio dimostra che l’incidenza di chiusura spontanea del difetto del setto interventricolare, localizzato nell’area centrale del setto, è probabilmente più alta di quanto ci si attendeva. In questo modo, alcuni pazienti, ai quali inizialmente era stata fatta diagnosi di diverticoli ventricolari a livello apicale e marginale del setto,in realtà possono aver avuto una chiusura spontanea del difetto del setto interventricolare. Questo risultato può incidere sulle percentuali precedentemente riportate sia per quanto riguarda i diverticoli ventricolari sia per quanto riguarda la chiusura spontanea del difetto del setto interventricolare.
Similar content being viewed by others
References/Bibliografia
Graham TP, Bender HW, Spach MS (1989) Ventricular septal defect. In: Adams FH, Emmanouilides GC, Reimenschneider TA (eds) Moss’ heart disease in infants, children and adolescents, 4th edn. Williams and Wilkins, Baltimore, pp 189–209
Hoffman JLE, Rudolph AM (1965) The natural history of ventricular septal defects in infancy. Am J Cardiol 16:634–653
Miyake T, Shinohara T, Nakamura Y et al (2004) Spontaneous closure of ventricular septal defects followed up from <3 months of age. Pediatr Int 46:135–140
Kantarci M, Ceviz N, Durur I et al (2006) Effect of the reconstruction window obtained at the isovolumic relaxation period on the image quality in electrocardiographic-gated 16-multidetector-row computed tomography coronary angiography studies. J Comput Assist Tomogr 30:258–261
Srichai MB, Hecht EM, Kim DC, Jacobs JE (2007) Ventricular diverticula on cardiac CT: more common than previously thought. AJR Am J Roentgenol 189:204–208
Kantarci M, Olgun H, Duran C (2008) Is it ventricular diverticulum, or closed muscular VSD? AJR Am J Roentgenol 190:374–375
Soto B, Becker AE, Moulaert AJ et al (1980) Classification of ventricular septal defects. Br Heart J 43:332–343
Moe DG, Guntheroth WG (1987) Spontaneous closure of uncomplicated ventricular septal defect. Am J Cardiol 60:674–678
Trowitzsch E, Braun W, Stute M, Pielemeier W (1990) Diagnosis, therapy, and outcome of ventricular septal defects in the 1st year of life: a two-dimensional colour-Doppler echocardiography study. Eur J Pediatr 149:758–761
Shirali GS, O’Brian Smith E, Geva T (1995) Quantitation of echocardiographic predictors of outcome in infants with isolated ventricular septal defect. Am Heart J 130:1228–1235
Hamamichi Y, Ichida F, Hashimoto I et al (2001) Isolated noncompaction of the ventricular myocardium: ultrafast computed tomography and magnetic resonance imaging. Int J Cardiovasc Imaging 17:305–314
Stollberger C, Finsterer J, Blazek G (2002) Left ventricular hypertrabeculation/noncompaction and association with additional cardiac abnormalities and neuromuscular disorders. Am J Cardiol 90:899–902
Ohlow MA (2006) Congenital left ventricular aneurysms and diverticula: definition, pathophysiology, clinical relevance and treatment. Cardiology 106:63–72
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kantarci, M., Duran, C., Bozkurt, M. et al. Cardiac multidetector computed tomography (MDCT) of spontaneously closed ventricular septal defect. Radiol med 114, 370–375 (2009). https://doi.org/10.1007/s11547-009-0381-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-009-0381-y